 |
|
New results help predict treatment response in colorectal cancer
September 17, 2008Genetic testing can identify a group of patients with advanced colorectal cancer who are likely to survive on average twice as long if treated with the drug cetuximab, late breaking results show.
At the 33rd Congress of the European Society for Medical Oncology (ESMO) in Stockholm, Dr. Christos Karapetis from Flinders University in Australia reports on a genetic analysis of 394 patients who took part in a phase III study comparing the monoclonal antibody cetuximab with best supportive care.
The latest analysis compared the effect of mutations in the K-Ras gene on overall survival and progression-free survival. The gene encodes a protein that is a key component of cellular signalling pathways, conveying extracellular growth signals from the cell surface to the nucleus. When growth factors bind to cell surface receptors, including epidermal growth factor receptor (EGFR), K-Ras is temporarily activated, facilitating regulated cell growth and proliferation.
The K-Ras gene is mutated in up to 35% of colorectal cancers. These mutations keep K-Ras stuck in its active form, switching on signalling without the requirement for EGFR stimulation.
Dr. Karapetis and colleagues found that patients with mutated forms of K-Ras had a median overall survival of 4.6 months when treated with cetuximab, and 4.5 moths with supportive care. In contrast, among those with wild-type forms, overall survival jumped to 9.5 months when treated with cetuximab, compared to 4.8 months with best supportive care.
The results show that determining K-Ras mutation status should be considered a new standard of care for selecting patients for targeted therapies against EGFR, the authors say.
Also at the congress, Professor Eric Van Cutsem from University Hospital Gasthuisberg, Leuven in Belgium will present data on the impact of K-Ras mutations from the Crystal study, in which patients were randomized to either the chemotherapy combination "FOLFIRI" or FOLFIRI plus cetuximab, in first line metastatic colorectal cancer.
Professor Van Cutsem recently reported that the combination of cetuximab and FOLFIRI significantly improves progression free survival and response rate in patients with a K-Ras wild type. In Stockholm he will present new data on survival in the Crystal trial.
"Overall survival in all patients included in the trial was identical in both treatment arms. There was however a strong trend towards a longer survival in patients with a K-Ras wild type tumor treated with cetuximab/FOLFIRI," he said. The median survival was 24.9 months for patients who received the cetuximab combination, versus 21.0 months (HR: 0.84). The overall survival results in patients with K-Ras mutant tumors did not differ in the two study arms.
In another study, Dr. Miriam Koopman from the University Nijmegen Medical Centre St. Radboud in The Netherlands, reports that the number of tumor cells found circulating in the blood of patients with advanced colorectal cancer is another valuable predictor of survival.
Her group studied 467 patients who were being treated within a prospective clinical trial (CAIRO2 of the Dutch Colorectal Cancer Group) with chemotherapy plus bevacizumab, with or without the addition of cetuximab. In each patient they measured levels of circulating tumor cells before treatment, and at different stages during treatment.
"Circulating tumor cell (CTC) level might be an indicator of the aggressiveness of disease," Dr. Koopman explained. "Thus, a high CTC level before initiating therapy in metastatic colorectal cancer patients is an inferior prognostic factor in our study."
The results show that the median progression-free survival time for patients with less than three CTC in every 7.5mL of blood was 10.5 months, compared to 8.2 months for those with three or more. Furthermore the median overall survival time for patients with less than three CTC in every 7.5mL of blood was 22.2 months, compared to 13.7 months for those with three or more.
"In our study CTC in metastatic colorectal cancer patients proves to be an early prognostic marker," Dr. Koopman said. "Prospective trials are needed to investigate whether a change in therapy based on CTC is beneficial."
European Society for Medical Oncology
The K-Ras gene is mutated in up to 35% of colorectal cancers. These mutations keep K-Ras stuck in its active form, switching on signalling without the requirement for EGFR stimulation.
Dr. Karapetis and colleagues found that patients with mutated forms of K-Ras had a median overall survival of 4.6 months when treated with cetuximab, and 4.5 moths with supportive care. In contrast, among those with wild-type forms, overall survival jumped to 9.5 months when treated with cetuximab, compared to 4.8 months with best supportive care.
The results show that determining K-Ras mutation status should be considered a new standard of care for selecting patients for targeted therapies against EGFR, the authors say.
Also at the congress, Professor Eric Van Cutsem from University Hospital Gasthuisberg, Leuven in Belgium will present data on the impact of K-Ras mutations from the Crystal study, in which patients were randomized to either the chemotherapy combination "FOLFIRI" or FOLFIRI plus cetuximab, in first line metastatic colorectal cancer.
Professor Van Cutsem recently reported that the combination of cetuximab and FOLFIRI significantly improves progression free survival and response rate in patients with a K-Ras wild type. In Stockholm he will present new data on survival in the Crystal trial.
"Overall survival in all patients included in the trial was identical in both treatment arms. There was however a strong trend towards a longer survival in patients with a K-Ras wild type tumor treated with cetuximab/FOLFIRI," he said. The median survival was 24.9 months for patients who received the cetuximab combination, versus 21.0 months (HR: 0.84). The overall survival results in patients with K-Ras mutant tumors did not differ in the two study arms.
In another study, Dr. Miriam Koopman from the University Nijmegen Medical Centre St. Radboud in The Netherlands, reports that the number of tumor cells found circulating in the blood of patients with advanced colorectal cancer is another valuable predictor of survival.
Her group studied 467 patients who were being treated within a prospective clinical trial (CAIRO2 of the Dutch Colorectal Cancer Group) with chemotherapy plus bevacizumab, with or without the addition of cetuximab. In each patient they measured levels of circulating tumor cells before treatment, and at different stages during treatment.
"Circulating tumor cell (CTC) level might be an indicator of the aggressiveness of disease," Dr. Koopman explained. "Thus, a high CTC level before initiating therapy in metastatic colorectal cancer patients is an inferior prognostic factor in our study."
The results show that the median progression-free survival time for patients with less than three CTC in every 7.5mL of blood was 10.5 months, compared to 8.2 months for those with three or more. Furthermore the median overall survival time for patients with less than three CTC in every 7.5mL of blood was 22.2 months, compared to 13.7 months for those with three or more.
"In our study CTC in metastatic colorectal cancer patients proves to be an early prognostic marker," Dr. Koopman said. "Prospective trials are needed to investigate whether a change in therapy based on CTC is beneficial."
European Society for Medical Oncology
Colorectal Cancer Current Events and Colorectal Cancer News RSSCT colonography offers 1-stop screening for cancer and osteoporosis
New research reveals that computed tomography (CT) colonography, also known as virtual colonoscopy, has the potential to screen for two diseases at once-colorectal cancer and osteoporosis, both of which commonly affect adults over age 50.
Screening for colorectal cancer detects unrecognized disease
Screening for colorectal cancer detects four out of ten cancers and should be carefully designed to be more effective, according to a study published today on bmj.com.
A Simple Blood Test for Colon Cancer
People are often reluctant to undergo a routine but painful colonoscopy ― but the consequences can be fatal. According to the American Cancer Society, colon cancer is the third most common cancer found in American men and women and kills about 50,000 Americans every year.
New platinum-phosphate compounds kill ovarian cancer cells
A new class of compounds called phosphaplatins can effectively kill ovarian, testicular, head and neck cancer cells with potentially less toxicity than conventional drugs, according to a new study published this week in the journal Proceedings of the National Academy of Sciences.
Survival of head and neck cancer patients is greatly affected by coexisting ailments
Current estimates for head and neck cancer survival are largely inaccurate because they widely disregard many of the most common diseases such patients have in addition to their primary cancer, says Jay Piccirillo, M.D., a head and neck specialist at Washington University School of Medicine in St. Louis, the Siteman Cancer Center and Barnes-Jewish Hospital.
Home-based diet and exercise intervention improves elderly cancer survivors' physical function
A home-based program to improve exercise and diet led to significant, clinically meaningful improvement in body weight and physical function among older long-term cancer survivors in preliminary findings from the RENEW (Reach-out to ENhancE Wellness) trial.
Adalimumab may reduce health-care costs for Crohn's disease patients
Inflammatory bowel disease (IBD) is a term that refers to both ulcerative colitis (UC) and Crohn's disease (CD). IBD occurs most frequently in people in their late teens and twenties. There have been cases in children as young as two years old and in older adults in their seventies and eighties; men and women have an equal chance of getting the disease.
SNPs affect folate metabolism in study of Puerto-Rican adults
Researchers at Tufts University have gained further understanding of the genomic basis for altered folate metabolism and the content of uracil in blood DNA.
National call for cancer clinical trial system to be more responsive to community needs
Addressing the nation's continuing poor performance in cancer clinical trial participation, particularly among racial and ethnic minorities and low income groups, will require meaningful public involvement in the design and implementation of clinical trials, according to a landmark report released today.
Surgical Removal of Small Colon Polyps is Costly and Unnecessary
Polypectomy (the surgical removal of polyps by colonoscopy) of small polyps found during CT colonography is costly and unnecessary according to a study performed at the University of Wisconsin School of Medicine and Public Health in Madison, WI.
More Colorectal Cancer Current Events and Colorectal Cancer News Articles
 | What Your Doctor May Not Tell You About(TM) Colorectal Cancer: New Tests, New Treatments, New Hope (What Your Doctor May Not Tell You About...) by Mark Bennett Pochapin Colorectal cancer (cancer of the colon and/or rectum) is the second leading cancer killer in the United States - over 50,000 men and women die from it each year. This is a particularly alarming statistic since it is also one of the most preventable and most treatable forms of cancer. In fact, it is estimated that over one-third of colorectal cancer deaths could easily be avoided. But most people,... |
 | Positive Options for Colorectal Cancer: Self-Help and Treatment by Carol Ann Larson Colorectal cancer develops slowly over a period of several years, undetected, usually as polyps. It is a preventable and treatable disease if caught in time, yet most know little about how to read its symptoms. Written for the layperson, this book covers all the uncomfortable questions and answers about the disease, from prevention and warning signs, to screening and diagnosis techniques, to... |
 | American Cancer Society's Complete Guide to Colorectal Caner by American Cancer Society Don't die of embarrassment--get informed about colorectal cancer Although colorectal cancer is the third most common cancer found in men and women, you may be unaware of your risk and don't know what you can do to prevent this serious disease. You may be too embarrassed to ask your doctor about changes in your bowel habits or get screened for colorectal cancer. American Cancer Society's Complete... |
 | Be a Survivor: Colorectal Cancer Treatment Guide (Be a Survivor) by Vladimir Lange Dr. Lange’s comprehensive overview of cancer and treatment options offers detailed information using simple, concise language and a wide variety of color photos and drawings. Colorectal cancer patients need to know more about their disease, yet there is an overload of information. Be a Survivor gives the patient the specific, reliable and necessary information to make good decisions about their... |
 | Colorectal Cancer Written by world authorities on the subject, this reference comprehensively covers every aspect of colorectal cancer. Addressing the molecular mechanisms, genetics, identification, and therapy of disease, this guide covers new pharmaceutical developments, current screening protocols, and modern methods of disease management by specialists at renowned institutions such as the Royal Marsden... |
 | 100 Questions & Answers About Colorectal Cancer by David Bub Whether you're a newly diagnosed cancer patient, a survivor, or a friend or relative of either, this book offers help. The only text to provide the doctor's and patient's view. This book is an invaluable resource for anyone coping with the physical and emotional turmoil of this frightening disease. The authors consist of two oncologic surgeons and a cancer care social worker from Memorial... |
 | The American Cancer Society : Colorectal Cancer by Bernard Md Levin From America's leading cancer authority comes a patient's advocacy book for colorectal cancer patients--and their families--that offers medical expertise, practical advice, and emotional support.Colon and rectal cancers (or colorectal cancer) affect more and more people each year and account for about 11 percent of all new cancer cases and 10 percent of all cancer-related deaths. More than 95,000... |
 | Challenges in Colorectal Cancer The latest guidance on challenging and controversial aspects of colorectal cancerColorectal cancer is one of the most common forms of cancer in the US and Europe. Thousands of people are diagnosed with the disease every year and nearly half of these die as a result. As colorectal cancer is curable when detected early, a significant proportion of these deaths could be prevented by earlier... |
 | Colorectal Cancer: Dana-Farber Cancer Institute Handbook (Dana-Farber Cancer Institute Handbooks) Written by eminent authors, Colorectal Cancer - a title in the Dana-Farber Cancer Institute series - is produced in full color and is richly illustrated throughout, providing a review of each cancer including its incidence, epidemiology, etiology and histopathology, together with the clinical features. Diagnostic studies and current clinical and pathological staging are also given. Detailed... |
| Colorectal Cancer by Harold J. Wanebo |
| © 2008 BrightSurf.com |